Provider Demographics
NPI:1639515398
Name:ISSA, OMAR M (DO)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:M
Last Name:ISSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 1ST ST APT 1202
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1861
Mailing Address - Country:US
Mailing Address - Phone:561-350-8824
Mailing Address - Fax:
Practice Address - Street 1:475 BILTMORE WAY STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5724
Practice Address - Country:US
Practice Address - Phone:305-443-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12687207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease